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CMS Chooses Eligible Regions for New CPC+ Initiative

August 1, 2016
by Rajiv Leventhal
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The Centers for Medicare & Medicaid Services (CMS) has announced the 14 regions in which practices will be eligible to apply for the agency’s new five-year Comprehensive Primary Care Plus (CPC+) model.

In April, CMS announced a new initiative with the aim to transform how primary care is delivered and paid for in America. Building on the Comprehensive Primary Care initiative from 2012, the new CPC+ model is a five-year primary care medical home model beginning January 2017 that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care, CMS says.

CPC+ is an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program, the agency says. CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model. Primary care practices will participate in one of two tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments to allow greater flexibility in how practices deliver care.

In the April announcement, CMS said participating practices would receive data on cost and utilization, and that optimal use of health IT and a robust learning system would be essential in supporting them in making care delivery changes and using the data to improve their care of patients. And, according to CMS, Track 2 practices’ vendors will sign a Memorandum of Understanding (MOU) with the agency that outlines their commitment to supporting practices’ enhancement of health IT capabilities. These partnerships “align with the Office of the National Coordinator for Health IT (ONC) priority to ensure electronic health information is available when and where it matters to consumers and clinicians,” CMS said.

In May, CMS announced that the CPC+ initiative will be open to 1,500 eligible primary care practices currently in the Medicare Shared Savings Program (MSSP). Originally, the federal agency said that accountable care organizations (ACOs) would be shut out of the forthcoming Comprehensive Primary Care Plus program.

Now eligible in 14 regions across the U.S., CPC+ is a multi-payer model؅—Medicare, state Medicaid agencies, and private insurance companies partner together to support primary care practices—so CMS selected the regions based on payer interest and coverage. “By aligning Medicare, Medicaid, and private insurance, CPC+ moves the healthcare system away from one-size-fits-all, fee-for-service to a model that supports clinicians delivering the care that best meets the needs of their patients and improves health outcomes,” CMS stated.

The following regions were selected for CPC+. Eligible practices in these 14 regions may apply between August 1 and September 15, 2016 to participate in CPC+:

        1. Arkansas: Statewide

        2. Colorado: Statewide       

        3. Hawaii: Statewide

        4. Kansas and Missouri: Greater Kansas City Region

        5. Michigan: Statewide

        6. Montana: Statewide

        7. New Jersey: Statewide

        8. New York: North Hudson-Capital Region

        9. Ohio: Statewide and Northern Kentucky Region

        10. Oklahoma: Statewide

        11. Oregon: Statewide

        12. Pennsylvania: Greater Philadelphia Region

        13. Rhode Island: Statewide

        14. Tennessee: Statewide

“As a key part of CPC+, CMS and partner payers are committed to supporting primary care practices of all sizes, including small, independent, and rural practices,” Patrick Conway, M.D., CMS deputy administrator and chief medical officer, said in a statement. “We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our healthcare system. This model allows primary care practices to focus on what they care about most—serving their patients’ needs when and how they choose.”

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